Provider Demographics
NPI:1780959239
Name:MUNA, ARDELINA BORROMEO (LMP)
Entity type:Individual
Prefix:
First Name:ARDELINA
Middle Name:BORROMEO
Last Name:MUNA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111203
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1203
Mailing Address - Country:US
Mailing Address - Phone:253-961-5526
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-329-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60269997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist